NextGen Journal » John Corkerhttp://www.nextgenjournal.com
A platform for the next generation, run by a nationwide team of college studentsTue, 01 Jul 2014 18:10:04 +0000en-UShourly1http://wordpress.org/?v=3.5.1Young Voters: Policy, Not Politicshttp://www.nextgenjournal.com/2012/11/young-voters-policy-not-politics/
http://www.nextgenjournal.com/2012/11/young-voters-policy-not-politics/#commentsThu, 01 Nov 2012 13:00:26 +0000John Corkerhttp://www.nextgenjournal.com/?p=31360It's time to do away with all of these divisive, destructive politics, and begin to work together to create the kind of good, effective policy that this country so desperately needs.

I am deeply engaged in this year’s presidential election. It is the most important election of our generation. I hope I do not need to list for anyone the litany of crises with which our great nation is currently faced. Suffice it to say, America is worse off in nearly every major domestic area (unemployment, debt, education, health outcomes, energy prices and availability, etc.) than we were four, eight, or even twelve years ago.

And in the midst of all that, I am disgusted with the politics involved with it all. I am three months into a health policy fellowship in Washington D.C., where I live, work and breathe policy every day. I’ve learned about the process of policy-making, from conception to inception, and I’ve never believed more strongly in the power of good policy to affect millions of people’s lives in meaningful ways.

Unfortunately, the politics (and politicians) that populate the governing bodies of this city are our biggest obstacles to creating good, effective policies. Partisan politics — and the bickering, in-fighting, empty rhetoric, and wasted resources that go along with them — are the bane of this country’s existence, and are leading us over a cliff of destruction. In his farewell address more than two hundred years ago, our founding father and first president, George Washington, tried to warn us:

“I have already intimated to you the danger of parties in the State… Let me now take a more comprehensive view, and warn you in the most solemn manner against the baneful effects of the spirit of party generally… It exists under different shapes in all governments, more or less stifled, controlled, or repressed; but in those of the popular form it is seen in its greatest rankness and is truly their worst enemy… It serves always to distract the public councils and enfeeble the public administration. It agitates the community with ill-founded jealousies and false alarms; kindles the animosity of one part against another; foments occasionally riot and insurrection… A fire not to be quenched, it demands a uniform vigilance to prevent its bursting into a flame, lest, instead of warming, it should consume.”

Sound familiar? He was right. We didn’t listen. And now nearly every politician who identifies with a political party uses his or her empty politics not to make this country better, but rather to kick our troublesome cans further down the road to national futility, all in the interest of keeping their jobs.

You see, our system of government was constructed so that farmers, post-men, police-men, doctors and laborers could take a few years off, serve their country, and then return to their livelihoods. They already had other jobs. And under this system, elected officials were focused solely on doing the best job possible during their limited time in office, free from many of today’s perverse incentives and outside interests. The term “career politician” would have elicited very confused looks from our founding fathers. It wouldn’t have made any sense back then, and it shouldn’t make any now.

It’s time to do away with all of these divisive, destructive politics, and begin to work together to create the kind of good, effective policy that this country so desperately needs.

My Involvement

I will most certainly be voting on November 6. The privilege of voting — and the responsibility to do so in an informed fashion — is the most sacred civic pact we citizens have with the future of our nation. I will not, however, be volunteering for any political campaigns for reasons I hope are clear from my comments above.

My Vote

While I have decided for whom I will vote in all other races in the “Big Kahuna” state of Ohio, I remain undecided as to whom I will vote for in this year’s presidential election. To put it simply, after months of personal research and reflection (as a replacement for empty campaign rhetoric), I find myself torn between the values I espouse as a student of Catholic Social Teaching and the difficult economic realities currently faced by our country. I will have it figured out by election day.

My Issues

1. Health Care: We cannot heal our economy until we first control health care costs. In addition, a healthy country is a productive country. Over the next four years, we must not only control health care costs, but we must simultaneously train more doctors and insure more people so that America is more healthy, more of the time.

2. Job Creation: Over the next four years, we must lower taxes on small businesses. We need them to hire people.

3. Energy Policy: Over the next four years, we must make greater use of our massive domestic energy resources in order to move further towards energy independence. This is of vital importance not only to domestic productivity, but to national security.

4. Women’s Health: It is vitally important that we do everything in our power to provide affordable and comprehensive health care for the women of this country. In doing so, however, we must come to a point as a nation where we do not confuse commitment to this important issue with support for unlimited abortion rights or free contraception. What’s more, we must come to this point without infringing upon the first amendment religious freedoms of any of our citizens.

My Campus

While I don’t currently study on a campus, I can tell you that the environment in Washington D.C. (and among my friends) is enlivened and impassioned. November 6 — and the days following — will be an event to behold.

]]>http://www.nextgenjournal.com/2012/11/young-voters-policy-not-politics/feed/0On Health Care, Obama, Romney Work to Differentiate Themselveshttp://www.nextgenjournal.com/2012/10/on-health-care-obama-romney-work-to-differentiate-themselves/
http://www.nextgenjournal.com/2012/10/on-health-care-obama-romney-work-to-differentiate-themselves/#commentsThu, 04 Oct 2012 15:13:12 +0000John Corkerhttp://www.nextgenjournal.com/?p=30353The relatively short amount of time the candidates spent debating health care was well worth it. Both candidates were more specific as to how their plans for the future of health care actually differ; and the disparities were noticeable.

]]>President Obama and Governor Romney squared off in the first of three presidential debates Wednesday night. It was a debate focused solely on domestic issues, with 60 percent of the time allotted for the economy, 20 percent for the role of government and 20 percent for health care.

In actuality, both candidates consistently overran their allotted time to speak, often talking over the futile attempts of moderator Jim Lehrer (executive editor and former anchor of PBS News Hours) to cut them off and move on. As a result, nearly three quarters of the debate was spent differentiating their views on job creation and tax codes.

But the relatively short amount of time they spent debating health care was well worth it. Both candidates had spent the months leading up to the debate attempting to differentiate their plans with rhetoric and histories that were ironically very similar. On Wednesday night, however, both candidates were more specific as to how their plans for the future of health care actually differ; and the disparities were noticeable.

Regarding the hot topic of Medicare, Obama explained that he planned to “protect and strengthen” Medicare not by changing its current delivery model, but by reducing overall costs of health care (no specifics offered) and by cutting costs within the Medicare program. He claimed that his administration had already saved or recovered $50 billion in Medicare dollars by cracking down on fraud and abuse. He also noted the $600/year that each Medicare beneficiary (and, by association, the government) was saving on prescription drugs through programs established under the Affordable Care Act. He proposed $716 billion in further Medicare savings over the next decade by reducing reimbursement payments to health insurance companies (through the Medicare Advantage program), hospitals and physician providers.

It is with this last proposal that Governor Romney took particular exception. He labeled these $716 billion in “savings” as “cuts,” that would negatively impact all current and future Medicare beneficiaries. And he claimed that these enormous cuts to providers would cause more than 4 million current Medicare beneficiaries to lose their coverage, citing studies that indicated 15 percent of hospitals and nursing homes and 50 percent of doctors would stop seeing Medicare patients under such reimbursement cuts.

Romney, on the other hand, stated that – under his plan – Medicare would not change for anyone currently 55 years of age and older. For those younger than 55, Romney proposes to institute a tiered “premium support” program that would provide beneficiaries with a fixed amount of money (based upon their income) that each could apply towards the purchase of their own, private health insurance plan. He claimed that a government option (similar to current Medicare) would be available to compete alongside these private plans, and that “at least two” different plans would be available at no cost to the beneficiary. Romney proclaimed that all beneficiaries should be allowed to choose their health care plan, and that market forces should be allowed to take the lead in lowering costs and increasing efficiency.

But Obama labeled Romney’s plan for premium support as nothing more than a “voucher” system, citing his own economic studies that indicated Romney’s plan would increase costs for each beneficiary by $6,000/year. He also claimed that the option for so many different plans would allow for “cherry-picking” on the part of private insurance companies of younger, healthier beneficiaries; ultimately leaving the government option to suffocate under the weight of their sicker, more expensive counterparts.

Regarding the state-based Medicaid program, Obama’s views have been clear ever since “Obamacare” was passed in 2010. Under the ACA, in an attempt to significantly reduce the number of uninsured Americans, all states are encouraged to expand their Medicaid programs to cover all citizens earning up to 133 percent of the federal poverty level. The federal government promises to pick up 100 percent of the cost of this expansion for the first few years, ultimately scaling back their support to 90 percent of costs within five years.

But Romney plans to “repeal and replace Obamacare on day 1″ of his term. And while he would replace the ACA with many programs already in place under it, his plan for Medicare is quite different. Romney proposes to replace the current system of federal Medicaid funding and oversight with a block grant system that would provide each state with the amount of money they received the previous year, plus inflation and an additional one percent. States would be allowed to use this money as they pleased, in order to insure their own citizens. The former Governor stated that this freedom to “take care of their own poor” has been a wish of his colleagues across the country for years.

Romney went on to cite studies that claimed that, under Obamacare, health insurance costs would increase for every American by an average of $2,500/year (a claim that Obama denied, citing that group rates for the currently uninsured had decreased by 18 percent under the ACA). He also cited studies indicating 75 percent of small business owners say Obamacare makes them less likely to hire new workers, and 20 million people would lose their employer-provided health insurance coverage next year when the ACA takes full effect and businesses begin to drop coverage.

He continued to reiterate his distaste for the ACA’s Independent Payment Advisory Board (IPAB), a group of independently appointed health care experts and physicians charged with identifying feasible ways to reduce overall health care costs, calling it a “bunch of unelected bureaucrats who will dictate what care patients receive.”

Obama, of course, countered by stating that the IPAB is forbidden under the ACA from making any decisions regarding care received by patients, and that without the independently appointed board, patients would be left to the “merciless cost shifting” practices of private insurance companies. Furthermore, he incredulously pointed out that the ACA was based upon the very same principles that Romney applied to health care reform in Massachusetts and stated could be a “model for the nation.” He claimed that 50 million people would lose their health insurance if Obamacare was repealed.

Romney was quick to rebut, however, that his health care law in Massachusetts was a “bipartisan” initiative (unlike Obamacare), that it did not raise taxes on the wealthy like Obamacare, and clarified his statement that the program could serve as a model for “state-based programs across the nation,” not for a “federal” government “take-over” of health care. He reiterated his closely-held belief that the federal government was incapable of effectively lowering health care costs.

Ironically, towards the end of their back-and-forth, both candidates cited the Mayo Clinic as a “perfect example” of how their respective plans would be more effective. Obama cited Mayo’s emphasis on the ACA principles of coordinated care, primary care prevention and a pay-for-performance reimbursement model. Romney, on the other hand, cited Mayo as an example of “private market forces” working to provide care of the highest quality at lower costs.

Clearly, there will be a whole lot of fact-checking being done over the next couple of days. But there is no doubt that the two candidates took significant steps Wednesday night toward differentiating their plans for the future of health care in America. Which do you think has a better chance of reducing costs in health care while increasing quality, Romney’s “trickle-down economics” or Obama’s “trickle-down government?” While there is still much to be clarified and fleshed out, what has been a pretty murky issue to date for the discerning voter is beginning to clear up.

]]>http://www.nextgenjournal.com/2012/10/on-health-care-obama-romney-work-to-differentiate-themselves/feed/0On Health Care, Obama and Romney Must Tell It Like It Ishttp://www.nextgenjournal.com/2012/10/just-tell-it-like-it-is-health-care/
http://www.nextgenjournal.com/2012/10/just-tell-it-like-it-is-health-care/#commentsMon, 01 Oct 2012 14:21:49 +0000John Corkerhttp://www.nextgenjournal.com/?p=30214As a medical student, I wish that President Obama and Governor Romney would be more honest with the American public about the impact of their respective health care plans. Because in the end, the two candidates' views just aren't that different on this critical issue.

]]>President Obama and Governor Romney will square off in their first presidential debate on Wednesday, October 3 at 9:00 PM EST. They will do their best to differentiate their views on key issues like entitlement reform, tax law, economic policy and, most importantly, health care.

Despite their divergent rhetoric on health care, however, their views on specific aspects of the issue are not all that different. This past Wednesday, each candidate published his own “perspective” in the New England Journal of Medicine on the future of U.S. health care.

First of all, it’s important to point out that a few of their assertions in these pieces are either misleading or simply untrue (big surprise). In President Obama’s perspective, he states that under the Affordable Care Act (ACA), “economists” believe that family health insurance plans will be $2,000 less by 2019. This is misleading. There is not an economist in the world that would predict that an American family’s health insurance plan would be 2 cents less in 2019 than it is now, let alone $2,000 less.

However, there are a few left-leaning economists who predict that, by 2019, the average American family health insurance plan may be approximately $2,000 less than it would have been if not for the ACA. As it stands, health care costs will continue to rise under the ACA, and the average family plan will be much more expensive in 2019 than it is now.

His statement that, “we are building our health care work force, recognizing the demands of an aging population as well as the needs of people who will become newly insured,” is just blatantly false. The American health care system is currently short approximately 60,000 doctors, and that is while increasing numbers of Baby Boomers reach the age of Medicare eligibility and before 30 million currently uninsured Americans gain health insurance beginning in 2014.

And the ACA wants to cut funding to residency training programs for doctors. This does absolutely nothing to “build the health care work force,” but rather serves to exacerbate a provider shortage that has already reached a critical level.

Romney, on the other hand, wastes no time in continuing his misleading rhetoric that characterizes the ACA as some sort of “federal take-over” of American health care. The $700 billion private health insurance industry isn’t going anywhere under the ACA. However, this industry will be forced to make their services more efficient and affordable in response to statutes in the ACA (such as state-based health insurance exchanges) that make the health care “free market” more competitive. There’s nothing more American or capitalistic than true competition.

Furthermore, while Romney states that he will “repeal and replace” the ACA during his first day in office, his suggestions for replacement largely mirror programs already in place under the ACA (allowing young adults under age 26 to remain on parents’ health insurance, banning insurance companies from denying coverage for pre-existing conditions, etc.).

And Medicare under Romney’s stated plan certainly would not be similar to health insurance plans for members of Congress. Members of Congress do have a choice of plans, as he states, but they have their health care paid for with only minor co-insurance. Romney’s Medicare plan would provide fixed-amount vouchers for seniors to use toward the medical bills for which they themselves are ultimately responsible.

To be clear, I am not expressing personal opinions about any of the proposals mentioned above. As a medical student, I just wish that the candidates would be a little more honest with the American public. At the end of the day, regardless of who is elected, many programs currently in place under the ACA will continue. Both candidates will cut money from the Medicare program, and both will provide tax breaks and subsidies to those who need help to purchase insurance. And let’s not forget, “Obamacare” uses as its blueprint the same principles that Romney fought for (and now defends) as Governor of Massachusetts (albeit on a smaller state level).

So, in the end, the two candidates’ views aren’t as divergent on this critical issue as they’d like you to believe. And, going forward, it will be important to “fact check” everything both politicians say if health care truly is a lynchpin issue in deciding your vote come November 6th. We’ll get a chance to hear them explain themselves in real time on Wednesday. Here’s to hoping they make our job a little easier, and just tell it like it is.

]]>In one of its most anticipated decisions in a generation, the US Supreme Court voted 5-4 yesterday to uphold President Obama’s health care law almost in its entirety. The decision came as somewhat of a shock to even the most clued-in of Washington insiders. Based upon the five conservative Justices’ brash skepticism of the US Solicitor General’s oral arguments, most expected the nation’s highest court to, at the very least, strike down the law’s lynchpin individual mandate as unconstitutional. Two of America’s premiere news agencies were even fooled, as they initially reported erroneously that the law and its mandate had been struck down.

Months ago, during oral arguments, the Obama administration attempted to convince the Supreme Court that the penalty associated with its individual mandate was not a tax. In doing so, they hoped to skirt the Anti-Injunction Act (which would have barred the Court from ruling on the law until its “tax” actually took effect in 2014) and to invoke the Constitution’s Commerce Clause (which gives the Federal Government the right to regulate interstate commerce).

Paradoxically, Justices Roberts, Ginsburg, Sotomayor, Breyer and Kagan ultimately determined that the penalty was simultaneously a tax and not a tax. They ruled that its mere characterization by the Government as a “penalty” (and not a tax) was enough to render the Anti-Injunction Act obsolete, allowing the case to move forward. However, regarding constitutionality, they also ruled that while the individual mandate and its associated penalty were not an appropriate exercise of Congressional power to regulate interstate commerce, they did in fact lie within the Federal Government’s authority to tax; thus securing their constitutionality. Clear as mud, right?

But the Supreme Court did not uphold the entire law. In the end, they struck down the Federal Government’s authority to withhold federal Medicaid funding from states who choose not to participate in the law’s proposed expansion of the Medicaid program. They determined that withholding such funding would constitute an inappropriately coercive Federal intrusion into a Medicaid program whose administration traditionally falls under the jurisdiction of the states.

The biggest shocker of the day may not have come in the decision itself, but by whom the deciding vote was eventually cast. While most expected the swing vote to lie in the hands of moderately conservative Justice Anthony M. Kennedy (who had remained relatively silent during oral arguments), it was in fact conservative Chief Justice John G. Roberts (appointed by President George W. Bush) who tipped the scales in favor of his more liberal colleagues and authored the majority opinion. Chief Justice Roberts entered his term in 2005 with a clearly stated mission to discourage, at all cost, 5-4 decisions based clearly upon partisan, ideological lines. And, in this case, he emphatically reaffirmed that mission.

In his majority opinion, however, Chief Justice Roberts was explicit in stating that this ruling applied only to the constitutionality of Obama’s health care law, and did not in any way serve as a commentary on the “wisdom” of the law or its original passing. That judgment, he stated, lies in the hands of the people. In other words, while his court’s decision reaffirms the constitutional legitimacy of Obama’s health care law and most of its contents, it falls conspicuously short of an overt endorsement of the law as a necessarily “good” thing for the future of the country.

And it is toward this uncertain future that we must now turn our attention as the health care law continues its deliberate march toward full implementation in 2014. Yesterday’s ruling will certainly mean different things for different groups across the country. And the ruling undoubtedly brings with it as many questions as it does answers. For example, without its funding leverage, how will the Department of Health and Human Services ensure that all states will comply with its mandated insurance exchanges and Medicaid expansion? The law’s prospects for future cost savings depend largely upon universal buy-in and cooperation.

Initially, even within constituencies, meaning and opinion appear to be conflicted. Organized medicine has come out in clear support of the decision, as the American Medical Association (including its prominent Student Section), the American Medical Student Association, the American College of Physicians, and the American Association of Family Practice all cited the law’s expansion of access to care as their main reason for optimism. All organizations were clear, however, in their assessment that the law remains flawed in its current form and must continue to evolve in order to achieve optimal outcomes.

Many independent physicians, on the other hand, are dismayed by the decision. As grounds for their dissent, they cite many areas of continued uncertainty, such as the future of a pay-for-performance reimbursement model, potential limits on their right to conscientiously object to providing care that may clash with their moral and ethical convictions, and whether or not the law will adequately reign in the exponential growth of health care costs as a percentage of gross domestic product.

The Medicare Part D “doughnut hole” will continue to inch closed, as millions of US seniors happily save hundreds of dollars on their yearly prescription drug costs. However, Medicare continues to serve as the biggest contributor to our unsustainable rise in overall health care costs. And these hundreds saved in prescription drug costs will pale in comparison to the overall cuts that will be inevitable if the Obama administration truly intends for its health care law to reduce health spending in any meaningful way; a scary prospect in an election climate where seniors comprise the most active (and thus, influential) voting demographic.

At least 2.5 million young adults ages 19-25 will benefit from yesterday’s decision, as they will be allowed to remain on their parents’ health care plans. In addition, many more sick young people can rest easy as they are assured that their illnesses will not preclude them from receiving the life-sustaining care that they need. However, it is precisely this generation of young Americans that stands to bear the full weight of this law’s impact on our already gargantuan national debt, if the non-partisan Congressional Budget Office’s savings projections prove inaccurate.

Truly, it is this “next” generation who stands to gain or lose the most as a result of yesterday’s landmark Supreme Court decision. If Obama’s health care law survives the 2012 election and its aftermath, its meat and potatoes won’t even be implemented for another year. And that will only be the beginning. This generation of young Americans will be charged with utilizing the Affordable Care Act not as static doctrine, but as a dynamic framework upon which they can perpetually make improvements (not unlike our beloved Constitution) in order to build a health care system that truly ensures access and reduces costs.

One fact is universally agreed upon: the system of the past was not only failing, it was insidiously crippling America’s ability to prosper. Yesterday’s Supreme Court decision ensured nothing more than the opportunity for a different health care future; a future that, for better or for worse, will be entrusted to what this author hopes will be the next “greatest” generation of young Americans.

]]>http://www.nextgenjournal.com/2012/06/a-surprising-and-complicated-ruling-for-americas-health-care-future/feed/0Catholic Hospitals Oppose Contraception Mandate, Not Individual Mandatehttp://www.nextgenjournal.com/2012/06/catholic-hospitals-oppose-contraception-mandate-not-individual-mandate/
http://www.nextgenjournal.com/2012/06/catholic-hospitals-oppose-contraception-mandate-not-individual-mandate/#commentsThu, 21 Jun 2012 21:32:32 +0000John Corkerhttp://nextgenjournal.com/?p=25829The CHA's opposition to the HHS's contraception mandate is an expression of a position on one issue. It has absolutely no bearing on their support for the overall structure of the PPACA or its individual mandate.

]]>Last week, the Catholic Health Association (CHA) sent a letter to the Obama Administration officially opposing the Department of Health and Human Services’ (HHS) recent mandate that all health insurance plans provide birth control services completely free of charge to beneficiaries (without copay). The HHS created a nationwide uproar when it announced this new legislation back in February, and it quickly responded by softening the reach of the mandate. They decided to make exceptions for expressly religious institutions — such as churches and other places of worship — but not for non-profit organizations who are affiliated with religious institutions, most notably hospitals and schools.

The CHA initially accepted this so-called compromise as a “step in the right direction.” However, after much deliberation, the CHA stated in its letter to the White House last week that implementing the mandate as it is written would be “unduly cumbersome,” and that the compromise would be “unlikely to adequately meet the religious liberty concerns” of its member institutions. The CHA represents 600 hospitals and thousands of nursing homes and other health-related organizations across the country. In fact, one in six hospital patients nationwide are treated in Catholic hospitals.

Personally, I am a strong Catholic. So, naturally, I was pleased to read about the CHA’s decision to finally stand up for their fundamental right to religious liberty. However, I was embarrassed and appalled to read so many biased and inaccurate representations of this story published in Catholic and conservative-leaning media. They are nearly universally politicizing the issue by characterizing this move by the CHA as an about-face to their previous controversial support for the PPACA (otherwise known as ObamaCare). That characterization is both untrue and irresponsible.

The CHA’s opposition to the HHS’s contraception mandate is an expression of a position on a singularly vital issue to the religious values upon which they base their daily mission. It has absolutely no bearing whatsoever on their support for the overall structure of the PPACA or its lynchpin individual mandate. In addition, this position will have no effect (nor was it intended to have an effect) on the Supreme Court’s ruling regarding the individual mandate. Breaking news, folks: The ruling is in, dissenting opinions have been written, and we should all know the verdict by early next week.

The CHA supported (and still supports) the PPACA because it ensures equitable access to basic health care services for nearly all of their brothers and sisters in Christ (oh, and because they consequently stand to benefit significantly from a precipitous drop in uncompensated care). They reject the HHS’s contraception mandate because, after a great deal of good-faith and conscientious reflection on its language, they cannot support a measure that would require any American to provide a service that violates his or her most fundamental religious beliefs.

Many detractors would argue that, in rejecting the contraception mandate, the CHA and other religiously-affiliated institutions are in some way infringing upon women’s fundamental right to access contraceptive services. But this view is regrettably short-sighted. There are literally dozens of other avenues through which women across the country can obtain contraception, many of them at little or no cost to the consumer. And nobody, especially not any Catholic hospital, is trying to barricade these avenues. Regardless of one’s personal, religious or moral convictions regarding life in its many forms, most would agree that every American woman at least has the right to access affordable contraception. I only pray that these same reasonable people would recognize that the CHA and all like-minded institutions at least have the right not to provide it.

]]>http://www.nextgenjournal.com/2012/06/catholic-hospitals-oppose-contraception-mandate-not-individual-mandate/feed/0Students’ Futures and the Reality of D.C. Politicshttp://www.nextgenjournal.com/2012/05/students-futures-and-the-reality-of-d-c-politics/
http://www.nextgenjournal.com/2012/05/students-futures-and-the-reality-of-d-c-politics/#commentsWed, 02 May 2012 12:09:57 +0000John Corkerhttp://nextgenjournal.com/?p=24112Unsurprisingly, partisan gridlock in Washington has delayed a bill to extend lower interest rates on student loans. While politicians continue to bicker, the college plans of millions of students are left in the balance.

]]>Last Friday, the House voted 215-195 to pass H.R. 4628, a bill that would delay for one year a 100% increase in the interest rates (from 3.4% to 6.8%) on new federal undergraduate student loans. It is a bill that is almost certain to die in the Democrat controlled Senate, and one that President Obama has vowed to veto should it miraculously go through.

That’s right, the ideologues in Washington who we’ve elected to represent our best interests are once again marginalizing a large group of their constituents in the interest of partisan politics. Only this time is (almost comically) different. This time, both sides actually agree on the primary issue at hand. Both Republicans and Democrats feel strongly that interest rates on federal student loans should remain at the low (but temporary) 3.4% rate signed into law with bipartisan support by President Bush in 2007. They just can’t agree on how to pay for its nearly $6 billion price tag. And, facing a divisive decision and stuck in tough re-election battles, more than a dozen Republicans and Democrats each crossed party lines with their votes.

H.R. 4628, introduced by Republicans and passed by a Republican controlled House of Representatives, proposes to offset costs by repealing the Prevention and Public Health Fund contained in the Patient Protection and Affordable Care Act (PPACA). It is a fund – currently valued at $11 billion – that has been set aside for improvements to preventive health care services in America, including nutrition and exercise programs, as well as screening for breast and cervical cancer. The GOP justifies this proposal by pointing out that Democrats already pilfered $5 billion from the same fund in order to pass an extension of the payroll tax cuts earlier this year, and that President Obama had proposed cutting another $4.5 billion from this fund in his most recent budget.

Democrats argue, however, that the fund is integral to reducing overall health care expenditures in this country. They claim that the previous deductions were the only way they could get Republicans to cooperate with the payroll tax break, and that those same deductions make further cuts that much less desirable. What’s more, they point out that Republicans don’t just want the $6 billion necessary to pay for the extended cuts to student loan interest rates. Rather, the GOP is calling for repeal of the entire $11 billion fund, with the extra $5 billion going toward debt reduction.

As a result, Democrats have countered with a few suggestions of their own. In order to balance the budget impact of extending student loan interest rate cuts, they propose to eliminate either tax cuts for certain (mostly medical and legal) corporations or tax subsidies for oil companies. Staying true to their tax-averse mantra, however, Republicans have already indicated that they would oppose any legislation that included the elimination of these tax cuts for higher-earning companies.

So who gets left out in the cold? The real losers in this ideological battle are the roughly 7 million low and middle-income students across the country whose higher education is made possible by these low-interest loans. If their interest rates were allowed to double, the average student’s college costs would increase by roughly $1,000. When combined with the nearly 8% annual increase in the cost of a college education, this aggregate jump in costs could put higher education out of reach for many students across the country who are already struggling financially.

But college students are not just sitting idly by while their futures are being put on hold by the decision makers in Washington. Thousands of students have shown up to voice their opinions at each of President Obama’s recent stops to college campuses.

And students aren’t just worried about their own personal pocket books. It is clear that they understand the broader societal impact of the issue at hand. According to a recent joint report released by U.S. PIRG, the Young Invincibles, the Center for American Progress, and Campus Progress, “92 percent of young Democrats and 78 percent of young Republicans say that increasing financial aid and making college loans more affordable will help make the economy stronger.”

Our next generation’s focus on the big picture is as refreshing as our politicians’ narrow-minded bickering is frustrating. Unfortunately, while it’s certain that this broken Capitol Hill record will do nothing to fix our economy or our struggling education system, it’s uncertain as to when this particular issue will be resolved. In the meantime, while our politicians in Washington continue to mortgage all of our futures in the name of ideology, millions of students across the country will be left searching for new and better ways to finance their education and secure a better America for the next generation.

]]>http://www.nextgenjournal.com/2012/05/students-futures-and-the-reality-of-d-c-politics/feed/5Doctors Concerned By Increasing Use Of Synthetic Pothttp://www.nextgenjournal.com/2012/04/doctors-concerned-by-increasing-use-of-synthetic-pot/
http://www.nextgenjournal.com/2012/04/doctors-concerned-by-increasing-use-of-synthetic-pot/#commentsFri, 27 Apr 2012 12:04:14 +0000John Corkerhttp://nextgenjournal.com/?p=23972Synthetic marijuana use has been a growing phenomenon over the past few years - mostly among teens and young adults. NGJ's John Corker reports on this trend that has left doctors worried about unknown medical side effects.

]]>“Potheads” and casual smokers alike celebrated their unofficial national holiday this past Friday, April 20th. Nationwide, cannabis connoisseurs no doubt partook in a celebratory toke in honor of their favorite “weed.” What’s uncertain, however, is how many of these users were smoking actual marijuana leaves.

Synthetic marijuana use has been a growing phenomenon over the past few years – mostly among teens and young adults – with the American Association of Poison Control Centers reporting more than 4500 calls related to its use since 2010. Also known as K2, Spice, Mr. Smiley, and Blaze, synthetic cannabis is manufactured by blending plants and herbs like bay bean, blue lotus and red clover with synthetic chemicals. These chemicals are intended to mimic THC (the primary active chemical in cannabis), reproducing the euphoric “high” typically experienced when smoking natural marijuana.

Previously available for purchase in gas stations, convenience stores and on the internet, synthetic marijuana has recently been outlawed in the United States and classified as a Class 1 controlled substance (a classification that also includes natural marijuana and heroin). However, much like it’s naturally growing “twin,” the illegality of its use has not slowed its growth or popularity. According to a study published in the March issue of the journal Pediatrics, more emergency departments across the country are seeing a rise in the number of patients who have used synthetic marijuana.

Although this synthetic drug is considered to be stronger than it’s natural counterpart, there is little in the medical literature regarding its contents, adverse reactions, or overdose. The biggest concerns for emergency physicians lie in their relative lack of knowledge regarding the drug as well as their difficulty in diagnosing its use. Since the drug is not regulated, it is impossible to know exactly which ingredients are used to produce each batch. As a result, side effects vary in both nature and severity, making recognition and treatment very difficult for physicians who have not had much experience with this relatively new drug.

Making matters worse, synthetic marijuana is undetectable on a standard urine drug screen, requiring a more extensive battery of testing typically ordered only with a high index of suspicion on the part of the physician.

Synthetic marijuana use has been linked to side effects such as rapid heart rate, profuse sweating, agitation, aggression, restlessness and inability to speak. And these side effects are as non-specific as they are dangerous. In other words, their effective treatment is typically dependent on an accurate diagnosis of their root cause. Even more concerning is a 2011 report from a group of Texas doctors about three teenage patients who experienced heart attacks after smoking synthetic marijuana. Clearly, the dangers associated with delayed diagnosis and treatment are significant.

Anecdotal accounts from doctors have stated that certain anti-anxiety and anti-depressive drugs have been effective in stabilizing patients who are suspected to be suffering an overdose or adverse reaction to synthetic marijuana use. However, many more robust studies are necessary in order to establish an accepted standard of care. In the meantime, young people and parents alike are encouraged to exercise a greater sense of awareness regarding the issue and to immediately seek professional medical assistance if they notice their friends or children exhibiting the symptoms or behaviors mentioned above.

]]>Last week, the US Supreme Court heard oral arguments regarding a variety of topics pertaining to the Patient Protection and Affordable Care Act (PPACA), or “Obamacare,” as many conservative commentators like to refer to it. Monday and Tuesday were spent deliberating over the relative merits of even discussing the law at this point, as well as arguing the constitutionality of its individual mandate. Discussions proceeded as planned, and the the mandate’s constitutionality looks like it will be decided by the slimmest of margins (5-4) one way or the other.

Wednesday’s discussions offered intrigue of their own. The first item for discussion revolved around the viability of the overall law if its individual mandate were to be struck down. Legal counsel representing the 26 states who are challenging the PPACA argued that the whole law would have to be invalidated if its mandate was ruled unconstitutional.

Conversely, legal counsel for the government argued that, without the individual mandate, only a few of the law’s statutes would have to go; namely the statutes guaranteeing coverage regardless of pre-existing medical conditions and community rating for premiums (based upon age, geographic area, tobacco use, etc.). The government also argued that many of the law’s provisions – some of which Americans are already benefiting from – could not only stand on their own, but do little if anything to affect the states that are lobbying so hard against them.

The Justices’ opinions were mixed on the matter, but if precedent is any indication, then it looks like at least part of the law will be allowed to stand when the dust settles. To date, the PPACA has been challenged more than two dozen times in lower courts, and only once has the entire law been struck down.

And, as if matters weren’t interesting enough, the court invited an expert guest to weigh in on the matter. Attorney H. Bartow Farr III argued against both the states and the government, asserting that striking down the individual mandate would not render any other part of the law obsolete, including guaranteed coverage and community rating for premiums. Farr believes that government insurance subsidies will adequately incentivise a broad enough range of patients to purchase insurance in order to make these provisions work.

In other words, he believes that critics (on both sides of the aisle) are grossly overestimating the number of citizens who will refrain from purchasing their health insurance until they are sick or in need. Regardless, he believes that the law will “open the market to millions, and lower premiums for millions” even without the individual mandate.

The second item on the agenda Wednesday was whether or not the federal government was inappropriately “coercing” states to comply with the PPACA’s expansion of Medicaid coverage (to approximately 16 million Americans beginning in 2014). The states argued that the federal government is usurping their state sovereignty (Medicaid is run by the states) by threatening to cut all Medicare funding if they do not comply with standards set for insurance exchanges and increased Medicaid enrollment.

The government, however, claims that they do no such thing by providing 100% of the funding for this expansion (the Feds usually cover about two-thirds of states’ annual Medicaid costs anyway) through 2016, gradually drawing that support down to 90% by 2020. This represents a $434 billion increase in federal Medicaid funding over that time.

Interestingly, one of the Justices pointed out that the PPACA simply states that HHS Secretary Kathleen Sebelius “at her discretion” can withhold any amount of funding that she seems appropriate for non-compliant states. Threats to withhold crippling levels of funding were nowhere to be found. Another Justice closed the day by pointing out that half of the states are not challenging the PPACA in this case, thus implying that half of the states are expressing tacit endorsement for what they may feel is a “good thing.”

Final deliberations on all issues were concluded by the Justices on Friday, and a vote was taken. However, the Supreme Court will not make their decision public until June. In the meantime, Justices will spend a great deal of time writing their majority and dissenting opinions. It is not unprecedented during this long, involved process for a Justice or two to change their mind, and nothing is final until the decision is publicly announced in a few months. Until then, media predictions and conjecture will abound regarding “what this means” for the health care future of America.

Regardless of its nature, the Supreme Court’s decision in this case will undoubtedly have a profound effect on that future. Check back in the coming months for much more analysis and many more opinions from your very own NGJ contributors.

]]>http://www.nextgenjournal.com/2012/04/health-care-arguments-conclude-decision-looms/feed/0The Court Hones in on the Individual Mandatehttp://www.nextgenjournal.com/2012/03/a-day-in-court-for-the-individual-mandate/
http://www.nextgenjournal.com/2012/03/a-day-in-court-for-the-individual-mandate/#commentsWed, 28 Mar 2012 13:09:23 +0000John Corkerhttp://nextgenjournal.com/?p=22536Oral arguments in the pivotal Supreme Court case regarding the PPACA continued on Tuesday, with sharp critiques from the conservative judges over the law's individual mandate. NGJ's John Corker provides the details on the current state of the case as well as the potential road ahead.

]]>Oral arguments regarding the Patient Protection and Affordable Care Act (PPACA) began on Monday. It is arguably the most critically important case to be heard before the United States Supreme Court in our generation’s lifetime. When all is said and done, its outcome will significantly alter the lives of some fifty million Americans. And the decision of the Court will reflect a precedent-setting (or perhaps more aptly, re-setting) interpretation of the US Constitution. The Court hopes to have a decision before July 1, but in its beginnings, it is a debate rich in history and intrigue. Here’s an update on what we’ve seen so far, and what we can expect in the coming days, weeks and months:

On Monday, the Supreme Court heard oral arguments as to whether or not the case should even be heard at this point. Dating back to the 19th century, the Anti-Injunction Act (AIA) stipulates that no new federal tax can be challenged in court until the tax has actually taken effect. The PPACA’s individual mandate (which isn’t scheduled to take full effect until 2014) has been the focal point of contention for its opponents, and some argue that the proposed penalty for non-compliance is equivalent to a tax. Ironically, both the Obama administration and its challengers argued Monday that the penalty is not a tax in hopes that the case would proceed as planned. Justices Breyer and Ginsburg agreed that the penalty was not a tax, spurring the proceedings on to Day Two.

Tuesday provided the battle ground that everyone had been waiting for. On Day Two, the court heard oral arguments regarding the constitutionality of the PPACA’s individual mandate; considered by most to be the lynch-pin component of the entire law, and certainly the focal point of legal contention since the law’s inception in March 2010. The positions of each side were clear. And if the Justices’ comments were any indication of the way they’ll eventually vote, then the entire law may be in serious trouble.

Lawyers arguing for the opposition claimed that the PPACA’s individual mandate forces “inactive” Americans to be active members of the health care market by purchasing a commercial product that they do not want, effectively creating a dangerously slippery slope that could lead to federal mandates to purchase cars, cell phones or even broccoli. Attorneys representing the Obama administration, however, argued that all Americans are “active” participants in health care commerce (i.e. everyone uses health care services) at multiple points from birth to old age. And, administration attorneys continued, choosing not to carry health insurance leads directly to a massive cost-shift (estimated at $43 billion/year) to insured consumers in the form of increased premiums. Both sides were subject to sharp questioning from the Justices and, at the end of the day, the futures of both the individual mandate and the law built upon it seemed in the balance.

Today, on Day 3 of oral arguments, Justices will hear testimony on the constitutionality of the PPACA’s Medicaid expansion (accounting for approximately half of the estimated 32 million beneficiaries who will be newly covered under the law). Opponents argue that the expansion represents a federal imposition on states’ jurisdiction over the Medicaid program. In addition, Justices will discuss whether or not the PPACA can stand on its own if its individual mandate is, in fact, ruled unconstitutional.

After all arguments are heard, the Court will spend the next few months deciding the PPACA’s fate. If the law is allowed to move forward, then implementation will continue in ways largely unpredictable. Much of the law’s contents have yet to take effect, and it will continue to be challenged in its entirety if a Republican is elected President in 2012. But states will continue to construct their insurance exchanges, hospitals and clinics will continue to implement and perfect their Electronic Medical Records (EMR) systems, and citizens will continue to seek competitive insurance premiums without the fear of being disproportionately penalized for their pre-existing health conditions.

Conversely, if the law is crippled (either in its entirety or by ruling its keystone provision unconstitutional), then President Obama’s “signature policy achievement” will be rendered obsolete. Further, young people and seniors have gained the most from the portions of the PPACA that have already been implemented and, as a result, stand to lose the most if the law is struck down. According to NPR, in my home state of Ohio alone, more than 80,000 young people currently covered under their parents’ health insurance will lose their coverage, and more than 180,000 seniors will be saddled with hundreds more dollars in prescription drug costs that they had previously saved since the PPACA’s inception.

Clearly, much is at stake during this week’s health care oral arguments in front of the Supreme Court. Stay tuned in the coming days, weeks and months for summaries and analysis of all of the proceedings.

]]>http://www.nextgenjournal.com/2012/03/a-day-in-court-for-the-individual-mandate/feed/1Why Primary Care is Often Not a Consideration for Medical Studentshttp://www.nextgenjournal.com/2012/02/why-primary-care-is-often-not-a-consideration-for-medical-students/
http://www.nextgenjournal.com/2012/02/why-primary-care-is-often-not-a-consideration-for-medical-students/#commentsMon, 27 Feb 2012 12:39:59 +0000John Corkerhttp://nextgenjournal.com/?p=21080Incentivizing medical students to pursue careers in primary care is hard, because of both money and misperceptions. But as the American population continues to both grow and grow older, doing so is essential to meet our health care needs.

]]>The Association of American Medical Colleges’ Office of Workforce Studies projects by 2015 — the year after the Patient Protection and Affordable Care Act is scheduled to add approximately 32 million patients to the ranks of the insured — we will have 63,000 fewer physicians than we need in the United States.

If nothing is done to address this critical shortage, then that number is projected to reach an astounding 130,600 by 2025. Unfortunately, as of this time one year ago, these “projections” had already become reality for 22 states and 17 medical societies across the country.

It’s true these current shortages and their projected exacerbation span all medical specialties in most areas of the country. But it’s also no secret their day-to-day strain is felt most heavily amongst primary care specialties and in the under-served areas of our urban and rural communities.

Already, foundational efforts are underway to begin to address our growing physician shortage. Existing medical schools across the country are increasing class sizes. And, since 2007, 18 new medical schools have opened and 10 more are in the planning stages. Many of these new medical schools have been created with the express purpose of training more primary care physicians.

Despite these new schools’ best intentions, however, they cannot force students to choose primary care specialties after graduation. And it’s precisely this challenge in recruiting medical students to primary care that will serve as arguably the biggest obstacle (adequate Graduate Medical Education funding for residency slots being the other) we face in our ongoing attempts to train enough doctors to meet our growing population’s needs. Before we can adequately tackle this daunting challenge, however, it’s important to first understand why medical students are avoiding these all-important primary care specialties.

The two-ton albatross sitting conspicuously in the middle of the room on this one is money. The average primary care physician earns between $175,000 – 200,000 per year, depending on the area of the country in which they live. At face value, that’s a very impressive sum of money. But consider that this amount is approximately half of the average earnings of a medical specialist.

In addition, consider the average educational debt carried by a medical student at graduation is approximately $160,000. Digging even deeper, this average debt figure is the product of a bimodal distribution. In other words, there are very few medical students who actually graduate with debt approximating $160,000. In reality, there is a very large group that graduates with approximately $80,000 in debt (those who receive familial assistance) and another very large group who graduates with approximately $240,000 in debt (those who are on their own).

Thus, we are left with very few students carrying “average” debt and two very large groups who are both more likely to gravitate toward higher-paying specialties. Since the $80,000 group is ostensibly comprised of students from more affluent backgrounds, it stands to reason these students will be more likely to pursue specialties allowing them to maintain the lifestyle to which they’ve become accustomed.

Additionally, the $250,000 group is more likely to pursue higher-paying specialties out of sheer economic necessity. Paying off a quarter-million dollar educational debt at an average of 6.8% interest (almost twice that of the average home mortgage interest rate) over 15-30 years (same pay-off period as a mortgage) can seem quite daunting to a young person who hopes to support a family and be able to afford an actual mortgage someday.

But money is certainly not the only disincentive for today’s medical students in pursuing careers in primary care. Just as damaging is the perception that primary care specialties are inherently more mundane than their higher-tech, procedure-heavy counterparts; often requiring longer hours for less exciting work. As Dr. John Donnelly, a Family Practitioner on faculty at the Wright State University Boonshoft School of Medicine says, “A lot of people think that all I see every day are sore throats and runny noses.”

It’s hard to get a medical student excited about spending 10-12 hours per day, five days per week wading through rapid-fire 15-minute appointments, prescribing and re-prescribing medications in an attempt to manage the chronic conditions of patients who are often unwilling or unable to play an equal role in that management.

But unlike the very real financial differences between primary care and medical specialties, this perception of the mundane primary care practice seems to depend more on the eye of the beholder. Of course, certain specialties are going to appeal differently to the myriad personalities and career goals of medical graduates across the country. But even from my limited clinical experience as a third-year medical student, I can confidently assert that the perception of some is far from an inherent reality.

Every Family Practitioner whom I’ve met on faculty at Wright State would tell you they love their job (and, by the way, none of them are going broke). I can say the same for my OB/GYN attending physicians, and they enjoy the added bonus of facilitating the miracle of new life each and every day. Additionally, on my outpatient (non-hospital) pediatrics month alone, I saw patients with interesting, rare diseases such as DiGeorge Syndrome, severe Polymicrogyria, Neonatal Lupus, brothers with Neurofibromatosis Type 1, and a vibrant, athletic 11-year old who had survived multiple open-heart surgeries after being born with Hypoplastic Left Heart Syndrome.

So how can we do more to overcome these obstacles (both real and perceived) to recruiting medical students into primary care? It stands to reason that the first step would be to systematically and longitudinally expose more medical students to the primary care setting from day one in their medical training. In this manner, students will be provided with a personal, first-hand window into the realities of primary care medicine.

Then, and only then, will they be able to definitively determine whether the unique aspects of a particular primary care specialty comprise a desirable match for the students’ unique personalities and career goals. In addition, more resources need to be devoted to primary care-specific post-graduate loan repayment programs, as well as to support efforts to replace the current government reimbursement formulas that value technology-heavy procedures needed to fix problems more than the preventative measures necessary to keep them from occurring.

Effectively incentivising medical students to pursue careers in primary care continually grows harder, especially as medical graduates’ financial burdens continue to escalate while popular perception of preventative care continues to decline. If properly prioritized, however, the resources are available to tackle this significant challenge. And as the American population continues to both grow and grow older, doing so will be essential to adequately addressing the nation’s ever-growing health care needs.

]]>http://www.nextgenjournal.com/2012/02/why-primary-care-is-often-not-a-consideration-for-medical-students/feed/0A Medical Student’s Hope for The State of the Unionhttp://www.nextgenjournal.com/2012/01/a-medical-students-hope-for-the-state-of-the-union/
http://www.nextgenjournal.com/2012/01/a-medical-students-hope-for-the-state-of-the-union/#commentsSat, 21 Jan 2012 18:05:02 +0000John Corkerhttp://nextgenjournal.com/?p=19110As a medical student with massive debt, I have only one reason to watch President Obama's address on Tuesday: to hear his plans for fixing health care. It's essential that we make it cheaper to become a doctor, and that we reduce delivery costs across the board.

]]>President Obama’s State of the Union address on Tuesday will undoubtedly serve as the launching point for his 2012 re-election campaign. In addition to updating America on his administration’s progress (or lack thereof) in areas both economic and diplomatic, Obama will be using this opportunity in front of a captive audience to begin to paint a portrait of promise for the “better” America that he hopes to lead through the year 2016. Most viewers will be eagerly awaiting Obama’s novel ideas on how to improve the economy and create jobs for the millions of talented Americans still struggling to find work. Many others will want to hear his plans for debt reduction, defense, and education. Unfortunately, according to a recent poll, only about 11% of Americans will be most anxiously anticipating President Obama’s comments on health care.

You can count me among that 11%. In fact, President Obama’s plans for fixing health care will be my sole purpose for watching his address on Tuesday. It’s pretty much the only thing on God’s green earth that could pry me away from studying just three days before the biggest surgical examination of my young life. I don’t care what he says about the economy. His thoughts on debt reduction are irrelevant to me. And I could care less what he wants to do to improve our national defense or our struggling education system. Why? Because it will be impossible to adequately address any of these areas until we fix health care. I won’t bore you here with the political and economic justification for this fact, as I’ve written about it before. But I will take this opportunity to put on my medical student hat and give you some experiential justification for why health care is the only topic for which I’ll tune in on Tuesday.

When I graduate medical school next year, I will own a full quarter million dollars in educational debt; 80% of which can be attributed to the cost of attending medical school. And this total is relatively small among students who do not receive financial support from their parents. Over the course of an average repayment period, with interest, I would end up paying nearly $600,000 in order to settle this debt. And it is solely because of this burden that I have eliminated nearly every primary care specialty (read: areas of need in every community across the country) from my future plans.

To be clear, I truly believe that some of these primary care specialties would promise an extremely enjoyable and fulfilling professional experience. In fact, all reimbursement being equal, Family Medicine would top my list of future specialties. But the harsh reality of my situation dictates a much higher-paying specialty choice, if I hope to relieve myself and my family from the burden of educational debt sometime before 2033. It’s a shame, because a medical student should never have to choose between the well-being of his or her family and the greater good of the community in which he or she lives. So on Tuesday, I want to hear President Obama’s plan for reducing the cost of medical education in order to create an environment where medical students are equitably incentivized to fill a broader variety of critically important needs in their profession.

What’s more, a growing number of enterprising physicians who work for themselves are being forced to close their doors to new Medicare and Medicaid patients (not a good thing with 32 million more scheduled to hit the market in 2013) because government reimbursement rates are too low to generate any sort of profit. And these same physicians will be forced to shut their doors completely to government-insured patients if threatened cuts to these reimbursements ever actually go through. Unfortunately, vital primary care physicians are already being forced to sell their practices to large hospitals because they can no longer afford to operate profitably in today’s system. Hospital reimbursement rates (buttressed by many high-tech, expensive procedures) have grown exponentially in comparison to those of primary care physicians over the past 25 years, and deep-pocketed super hospitals can afford to take short term losses in purchasing these practices in order to ensure their long-term financial growth. On Tuesday, I want to hear President Obama’s plan to create an environment that allows private practice physicians (medicine’s equivalent to the all-American small business owner) to stay in business.

Medicare also funds medical residency training positions across the country (one of which I hope to fill in a year’s time). Unfortunately, that funding is on the chopping block in the current well-intentioned – but ultimately misguided – Congressional deliberations about reducing health care costs. Does President Obama really expect physicians in training to take on 3-5 more years of debt instead of receiving what is already considered to be an inadequate salary? Does he really hope to address a national physician shortage of more than 20,000 (and growing) by further disincentivising bright young Americans from entering the medical profession? Those are questions that I want answered on Tuesday.

Just the other day, I was unable to order the medicine that my patient needed. The hospital (a huge, urban hospital with a Level 1 Trauma Center) was fresh out, as the drug was on national back-order due to shortages created by decreased production. It is one of many commonly used, inexpensive, exceedingly effective drugs that pharmaceutical companies have ceased to produce because it no longer meets their profit margin objectives. In this situation, I had to order an alternate drug with a similar primary effect, but that costs twice as much and causes more inconvenient side effects for my patient. Oh, and the bill for the CT scan (body imaging, press a few buttons from behind a window, takes about 10-15 minutes) that was necessary to rule out a fractured spine in this patient? $3,000. I just thought I’d throw that one in there. On Tuesday, I want to hear President Obama’s plan for creating an atmosphere among hospitals, pharmaceutical and technology companies that incentivizes them to produce the products that patients need at a price that they can afford.

Another one of my patients this past week came in because she had a serious complication from her inflammatory bowel disease, and she was in need of an expensive surgical procedure. She lost her job (and her health insurance) just before she was diagnosed with this disease about six months ago, and had been unable to afford the medications that she needed to keep it under control. She was also forced to switch to a less expensive, less effective asthma medication and stretch the prescription over a period of time much larger than was originally prescribed.

As a result, her asthma was very poorly controlled when she came to us, and she needed sophisticated breathing treatments every 4 hours during her stay in order to get her breathing status to a level that would be safe for surgery. All tolled, a hospital stay that could have been prevented with about $400 of preventative care ended up costing the hospital (and, by proxy, its other patients who actually have the ability to pay) $20,000 of unnecessary health spending. On Tuesday, I want to hear President Obama’s plan for making preventative health insurance plans both universally accessible and required (a necessary and precedented component of any truly workable plan to increase access and reduce costs) for all Americans.

Do you notice a theme here? Each of these problems ultimately boils down to money. The Patient Protection and Affordable Care Act (“Obama care”) includes some admirable components. But it is not the answer to these problems. It does nothing to create an atmosphere in which we can effectively reduce the cost of delivering health care. As things stand, health care costs continue to rise while American patients continue to suffer. And the PPACA will never be allowed to take full effect unless President Obama wins his re-election in 2012. If he hopes to do that, I suggest that he spend a significant amount of his allotted time Tuesday evening explaining to the American public exactly how he plans to relieve them from the suffocating burden of a broken health care delivery system that devours 1 out of every 5 dollars they earn. And if he doesn’t, I encourage every truly concerned American out there to join me in changing the channel…because nothing else he has to say would be worth hearing.

]]>Last week, in a highly unusual turn of events, Secretary of Health and Human Services Kathleen Sebelius overturned an FDA ruling that would have allowed “Plan B” emergency birth control pills to be sold over-the-counter (without a prescription) to any female of reproductive age. Currently, the FDA allows these drugs to be sold over-the-counter (OTC) to females seventeen years of age and older, while younger girls must have a prescription from their doctor. The product is stored behind pharmacy counters, and ID is required to verify a customer’s age.

Plan B is a single pill that sells for about $50. It consists of a high dose synthetic female hormone called progesterone and, when taken within 72 hours of intercourse, has been proven to effectively prevent pregnancy. This high dose of progesterone acts in two ways: 1.) By preventing the release of eggs from a woman’s ovaries (all but eliminating the opportunity for fertilization by sperm), and 2.) Impeding the proliferation of a woman’s uterine lining (preventing implantation should a rogue egg be fertilized).

The drug’s manufacturer, Teva Pharmaceutical Industries Ltd., had submitted an application to the FDA months ago to have the age limit on OTC sales lifted. In doing so, they cited study results from the Center for Drug Evaluation Research (CDER) that found the drug to be safe and effective in females twelve years of age and up. In addition, an FDA review board found the study’s results to reliably indicate that a clear majority of this age group understood that the drug was for emergency use only, that it would not protect against sexually transmitted diseases, and that this younger age group could safely and effectively use the product without the intervention of a health care professional. FDA commissioner Margaret Hamburg cited the scientific validity of these study results specifically in a statement regarding her decision to approve Teva’s application.

As would be expected, liberal leaning Women’s and Reproductive Rights organizations were outraged by this decision. In this case, they believe that President Obama – who has always billed himself as a champion for sound science – placed politics above science in anticipation of his 2012 re-election campaign. They feel that President Obama saw this as an opportunity to attract more conservative voters who consider Plan B to be an abortifacent and for whom “Right to Life” issues take precedence in their voting deliberation. Of course, they also feel that this decision comes at the calculated expense of a liberal base that is unlikely to vote for any of the myriad Republican candidates who differ from them on so many other important issues. And while this alleged calculation may just pay off for President Obama in the long run, many predict that he will take a big hit in the support of unmarried females under the age of 35. This demographic contains millions of college students and primarily liberal-leaning women who came out strongly for Obama in 2008 and for whom Women’s Reproductive Health is a key issue.

But left-leaning political groups aren’t the only ones outraged. Both the American College of Obstetrics and Gynecology (ACOG) and the American Academy of Pediatrics (AAP) issued statements in strong opposition to this decision. They cited the “significant implications” that unintended pregnancy can have on adolescent females’ physical and emotional health, especially in cases of rape and incest. In addition, they came out in support of the scientific validity of the CDER study’s findings, stating that “Emergency contraception is a safe, effective back-up birth control method for teens and women of all ages to prevent unintended pregnancy.” Moreover, many physicians are concerned that – due to the inherent limitations of their own time and resources – a prescription requirement may make it impossible for young girls to obtain Plan B emergency contraception within the 72 hour post-intercourse window necessary to prevent unplanned pregnancy.

Clearly this is an issue that will be hotly debated all the way through next year’s Presidential elections. In his 2008 campaign, President Obama vowed never to allow politics to interfere with or supersede sound science. And while its specific political implications are yet to be determined, 0ne thing we know for sure is that his decision to support Sebelius’ ruling will provide plenty of “flip-flopper” fodder for his Republican opponents in 2012.

]]>http://www.nextgenjournal.com/2011/12/obama-sebelius-and-plan-b-politics-vs-science/feed/2Incentivising Congress: Your Voice and Your Votehttp://www.nextgenjournal.com/2011/11/incentivising-congress/
http://www.nextgenjournal.com/2011/11/incentivising-congress/#commentsWed, 30 Nov 2011 20:47:39 +0000John Corkerhttp://nextgenjournal.com/?p=16818At the end of the day, our elected officials failed us. So if you are as tired and frustrated as I am that political bickering continues to trump the needs of our struggling nation, make sure you let them know.

]]>I’m sure that you’ve all heard by now: the ‘Super-Committee’ failed to do their job last week. They were unable to reach an agreement – by a previously agreed-upon Thanksgiving deadline – on where at least $1.2 trillion in Federal budget savings would come from in the coming year. As a result, $1.2 trillion in spending cuts – divided equally between domestic spending and defense – will automatically go into effect in 2013. And President Obama has threatened to veto any attempt to stop them. So where did the negotiations break down?

Comprising this bipartisan whine-a-thon, there were six Democrats insisting that a phase-out of the Bush-era tax cuts (on the wealthiest people in the world) be included in any debt reduction compromise. They were willing to cut spending in a variety of areas – including social “entitlement” programs such as Medicare – as long as there was a very specific source of “increased revenue” also adding to the savings. Problematically, there were an equal amount of Republicans on the committee who absolutely refused to allow those taxes to be touched (proposing only a tiny tax increase, more than offset by trillions of tax cut extensions). They claim that doing away with current tax rates would hurt small business owners and stifle job creators.

I find this claim to be very interesting. Doing away with the Bush-era tax cuts on the wealthy would effect only those who are currently making a lot of money. What’s more, this effect would mean simply going back to the same tax structure that was in place during the Clinton administration. Consequently, that was the last time that our Federal budget was balanced and that economic growth was not a topic of national concern. Under the current tax structure and economy, however, there seem to be a lot of small businesses and drivers of job creation who aren’t making a lot of money. In fact, dozens are going out of business every day.

None of these business owners and job creators would be effected by phasing out the Bush-Era tax cuts unless the economy improved and they achieved greater success. Just the other day, I listened to one of these nearly bankrupt small business owners tell NPR that he would gladly take an increase in taxes tomorrow if he had any business to be taxed, and that many of his struggling colleagues felt the same way. It sounds to me like our small business owners and job creators are already hurting. And the Republicans’ empty justifications for resisting plans to help are starting to sound much more like overly generalized political scare-tactics than reasoned attempts at a solution.

Not to be out-done in their stubbornness and irrationality, however, negotiations were similarly stalled when the Democratic members of the committee called for $700 billion in economic stimulus spending in one of their proposals. Really? Their job was to identify $1.2 trillion (or more) in savings, and they proposed more spending? One would hope that Democrats had learned at this point that stimulus spending is not the answer to our economic woes. But apparently in this case, political ideology once again prevailed over historical precedent. The Democrats claim that this extra spending would be off-set by savings from winding down the wars in Iraq and Afghanistan, but this too is widely considered to be more of a political accounting gimmick than real deficit reduction.

So why all of these continued gimmicks? Why are both sides still clinging to the same blind, progress-killing ideologies with which they began this process? After months of deliberation over one seemingly very clear task, why are we still without compromise?

Put very simply, because the politicians involved had no real incentive to get the job done. They knew that if they failed, then $1.2 trillion in savings would still be mandated. And they also knew that these cuts would not take effect until 2013, after the next round of elections. In other words, failure would have no effect whatsoever on them, their families, or their jobs. As a result, the only clear incentive under which they had to operate was re-election. Career politicians (an entirely foreign notion to our founding fathers) learn early these days not to confuse keeping their job with doing their job. Politicians are elected based upon their ideologies, not on their bodies of work (for two prime examples, just look at our last couple of Presidents). So the politicians comprising the ‘Super-Committee’ did what any of us would have done. They did what they thought they had to do to keep their jobs. They stuck to their misguided, ideological guns because that’s what we vote for. Sadly, they spurned compromise, because it could be misconstrued as “weakness” on the campaign trail.

At the end of the day, our elected officials failed us. They didn’t do the job that we sent them to do. And I’m sorry to say that I’m not all that surprised. This isn’t the first time that it’s happened, and it certainly won’t be the last under the status quo. But we can do something about it. Our democracy was and still is founded in the basic tenet of “government by the people, for the people.” These politicians work for you. So if you are as tired and frustrated as I am that political bickering continues to trump the needs of our struggling nation, then contact your elected officials right now. Tell them how upset you are with the ‘Super-Committee”s failure, and with any other of the myriad of failures of recent memory. Let them know exactly what kind of tangible progress will be needed in order to secure your support. And when it comes time to exercise your constitutional right to vote, if that progress hasn’t been made, then throw empty ideology to the wind…and give their job to somebody else.

]]>http://www.nextgenjournal.com/2011/11/incentivising-congress/feed/0Our Generation’s Health Care Futurehttp://www.nextgenjournal.com/2011/10/our-generations-health-care-future/
http://www.nextgenjournal.com/2011/10/our-generations-health-care-future/#commentsWed, 19 Oct 2011 09:30:55 +0000John Corkerhttp://nextgenjournal.com/?p=15161As the 2012 Presidential Election approaches, the rising cost of health care in the United States remains a pressing issue that has yet to be resolved. NGJ's John Corker reports on the causes behind the high costs while also looking ahead towards the future.

]]>The 2012 presidential election is just over a year away, and our health care system sits at a crossroads. Nearly one out of every five dollars produced by the US economy is spent on health care, and over half of US bankruptcies are attributed to medical expenses. This proportion continues to rise. We spend more money per person on health care than any other nation in the world; yet we do not even crack the top 25 in most major measures of health outcomes.

In order to feasibly access comprehensive health care services in this country, most of us need health insurance. Unfortunately, 1 out of every 7 Americans does not have health insurance; most of whom indicate that they simply cannot afford it. This 1 in 7 does not feel that they can afford insurance, because it is very expensive. And insurance is very expensive, because health care products and services cost a lot. None of this is new. None of this is rocket science. Yet, the nation has been arguing about how to effectively address this growing issue since Joey McIntyre, Jordan Knight, Jonathan Knight, Donnie Wahlberg and Danny Wood really were the New Kids on the Block.

A little over eighteen months ago, President Obama pushed major legislation through Congress that promised to reform the way we pay for health care services in America. Since that time, however, it seems as though the law has created more questions and debate than answers and consensus. Most notably, the legal battle over the Patient Protection and Affordable Care Act’s lynchpin individual mandate has made its way all the way to the Supreme Court. No one really knows when the case will actually be heard, but that may not matter. The major provisions of the PPACA aren’t scheduled to take effect until 2014, and the law is not expected to survive the 2012 elections if a Republican candidate emerges victorious. In other words, to date, the law that was once billed as President Obama’s signature political victory has not gotten us any closer to a more accessible, affordable health care system.

Their are many very complicated factors that contribute to this dilemma, but its foundation – the ugly, horrible, eye-averting problem that is harped upon ad nauseum by the media but never truly addressed by anyone in charge – lies in the complex costs associated with providing health care services in the United States. The reason health insurance is so necessary is that the average American’s health care needs are largely unpredictable, while health care products and services are largely unaffordable out of pocket for the “poorest” 99% among us.

The average cost of a physician’s office visit is approximately $155. A month’s supply of Accutane – a common acne medication – can cost between $500-1,500, depending on the supplier. An MRI can cost between $400-3,500, depending on the area of the body being imaged (MRI machines cost over $1 million on average). And a one-night stay in the hospital costs an average of $5,000. For reference, the median American household’s yearly income was $49,445 in 2010.

To be clear, the approximate costs outlined above reflect average figures across the country. Of course, the insured health care consumer pays barely a fraction of these actual costs out of pocket, with their monthly premiums serving as a longitudinal investment in their care. But for that 1 in 7, these costs often put health care services out of reach.

From where do the high prices of these services originate? The answer has three parts. First, medical technology and pharmaceutical companies charge very high prices for their products, and these companies justify charging so much for new technologies and drugs by pointing to the many years and millions (sometimes billions) of dollars that they invest in the research and development of their products; many of which are never even brought to market. However, despite these companies’ significant R&D costs, their profit margins remain some of the largest among American industries. But their CEO’s argue that this kind of profit margin is not only fair, but truly capitalistic for such a high risk industry.

Second, American physicians demand very high salaries (the average American hospital, by the way, barely breaks even). The lowest-paying medical specialty pays an average of almost $150,000 per year. This is three times the median American household income. Physicians and their supporters argue that the high prices they charge for their services are justified by the many years and dollars that they invest in their sophisticated training. At minimum, prospective physicians must commit eleven years of their life to training (including their undergraduate, pre-medical work). And by the end of this training, the average first-year physician has incurred almost $180,000 in educational debt (with the debt of many financially independent students reaching $250,000 or more). Even with their higher salaries, it takes the average US physician at least 20 years to pay off their educational debt with interest.

Third, a large portion of our health care dollars are spent on end-of-life care, and our elderly population continues to grow. While the average life expectancy for a US citizen currently stands at 78 years, it is estimated that a full 12% of our health care expenditures go toward just the final year of that span. In fact, in 2008 alone, Medicare spent $55 billion on just the last two months of patients’ lives; more than the budgets that year for the Departments of Homeland Security and Education. And it has been estimated that 20-30% of these expenditures may have had no meaningful impact.

While their relative merits are neither my responsibility to judge nor relevant to this article, the foundation of America’s very expensive health care clearly lies in the high prices charged by medical supply companies and physicians for their products and services, respectively, as well as the grossly disproportionate amount of money being spent on end-of-life care. To make matters worse, these prices and expenditures have caused health care costs to rise at an average rate 2.4% higher than GDP since 1970, and now threaten to cripple our national economy.

Compounding matters, we have a physician shortage in this country that is projected to reach 63,000 by 2015, with this shortage most heavily represented in critical primary care specialties. In other words, access to health care in the United States is increasingly limited not only by the price of products and services, but also by a severe shortage of the professionals needed to safely provide them. But this is not a problem solved by simply training more doctors. This issue too finds its origin in cost. US medical schools cannot admit more students without more residency training slots created in US teaching hospitals. US teaching hospitals cannot add more residency training slots without more federal funding. Did I mention that medical residency training slots are funded through Medicare? Yep, they are funded by the same Medicare coffers that legislators are threatening to slash in order to help solve a budget crisis that has become so severe in large part due to astronomical health care spending.

Clearly there are complex, myriad issues that contribute to the difficult crossroad at which our health care system currently lies. For the past two decades, the major debate seems to have been whether it is more important to decrease the costs of health care or increase access to it. For all of the reasons mentioned above, I argue that it will be impossible to increase access unless we first decrease costs. So how do we decrease costs?

Well, it’s going to take a team effort led by whomever emerges victorious from the 2012 elections. And make no mistake about it, any serious attempt at decreasing health care costs for the long term is going to hurt. It will take shared sacrifice. People making lots of money will need to take pay cuts. Corporations (and their dividend-hungry share-holders) are going to have to settle for smaller profit margins. Our elderly and their physicians are going to have to be more discerning about which products and services are really necessary toward the end of life. And my “next” generation needs to begin exercising positive life-choices now that will significantly decrease the amount of health care products and services that we’ll need to utilize in the future. How do we tangibly put these ideas into policy? I don’t have those answers; at least not right now. But I’m not running for the presidency in 2012.

Over the next year, the presidential candidates will debate a variety of important areas that need improving, and they will make many promises. But the person that occupies the Oval Office in January 2013 will not be able to keep those promises unless he or she reduces (or, at the very least, controls) health care costs. Unless the insidious growth of these costs as a percentage of our GDP is curbed, there simply will not be enough resources available to put people to work, better educate our children, or enforce effective immigration and foreign policies. This is the impact that health care will have on the 2012 elections, and on the future of our generation.

]]>http://www.nextgenjournal.com/2011/10/our-generations-health-care-future/feed/0Medical Students Favor ‘ObamaCare’- But Why?http://www.nextgenjournal.com/2011/09/medical-students-in-favor-of-ppaca-but-do-they-know-why/
http://www.nextgenjournal.com/2011/09/medical-students-in-favor-of-ppaca-but-do-they-know-why/#commentsTue, 27 Sep 2011 06:42:37 +0000John Corkerhttp://nextgenjournal.com/?p=14217Since 'ObamaCare' was signed into law, many have weighed in with their thoughts. But what about our nation's medical students- the future of the profession? A new study- "Healthcare Reform and the Next Generation"- gives some insight.

]]>It’s now been a year and half since the Patient Protection and Affordable Care Act (PPACA) was signed into law in March 2010. In those eighteen months, it seems as though nearly every imaginable American demographic has weighed in with their thoughts on the relative merits of our new health care law. And opinions vary widely.

Some state governments have sought to cripple the PPACA by challenging the constitutionality of the the individual mandate, the legislation’s lynchpin component; while others have already begun the process of planning and implementing the insurance exchanges called for by the law. Likewise, the American Medical Association (AMA) – the largest and loudest voice for physicians in America – has come out in support of the spirit and potential impact of the PPACA, while a silent majority of unaffiliated physicians disagree. And recent polls of the general population have come back split more or less down the middle between supporters and opponents of this controversial legislation.

Until this past week, however, one of our country’s most important demographics (at least as regards this issue) had yet to formally opine on the matter. The future of the medical profession – our nation’s medical students – shared their thoughts in a recent study entitled, “Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act,” published by the Public Library of Science.

One thousand two-hundred and thirty-two medical students, from ten US medical schools, responded to a survey inquiring about their thoughts on the PPACA. Overwhelming majorities agreed that the current US health care system is in need of reform (94.8%), and expressed support for the PPACA (80.1%). Surprisingly, despite all of the national push-back against the far-reaching, “big-government” scope of the new health care law, 78.3% of students feel that its attempt at reform has not gone far enough; this figure representing both supporters and opponents of the legislation. Most interestingly, however, only 53.9% of students indicated that they understand the major provisions of the PPACA, suggesting that some of the surveyed supporters’ opinions may be based more in conjecture than research and pragmatism. Moreover, nearly half of respondents indicated that they were unsure as to whether the PPACA would meet it’s stated objectives of increasing quality and access in health care (47.7%) or containing rising health care costs (45.4%). For the record, all results were fairly consistent across class years, stated political affiliations and future medical specialty choice.

Despite their overwhelming ideological support of the PPACA, when we dig a bit deeper, the results of this survey seem to indicate significant uncertainty among medical students about the components and potential impact of the law. This uncertainty is echoed by the general population, as approximately 38% of Americans indicate that they are “not at all knowledgeable” about the legislation.

However, it is reasonable for one to expect that our nation’s physicians-in-training be at least more knowledgeable than the general public about a law that has the potential to fundamentally change the way their future profession is run. Medical students are certainly very busy people, learning the basic sciences in only two years and spending two more mastering their application in the clinical setting. But students and their medical schools should be making more of an effort to incorporate knowledge of policy and the business of medicine into their admittedly crowded curricula. Likewise, both federal and state government should be making more of an effort to reach out specifically to our medical students. They are the future physicians who will be shepherding the PPACA into implementation (assuming it survives the 2012 elections), and they need to understand how and why it is supposed to work.

It is encouraging that medical students have finally been given a chance to speak out on this historic and controversial piece of health care reform legislation. However, it is clear that the future of medicine has much to learn before its voice is truly heard in the national conversation.